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Medical Director


This is a Full-time position in Work At Home, TX posted May 3, 2021.

•    Works to achieve quality outcomes for customers/members with a focus on service and cost 
•    Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills. 
•    Balances customer/member needs with business needs while serving as a customer/member advocate at all times. 
•    Participates in all levels of the Appeal process as appropriate and allowed by applicable regulatory agencies and accreditation organizations
•    Participates in coverage guideline development, development and maintenance of medical management projects, initiatives and committees.
•    Participates in quality processes such as audits, inter-rater reliability clinical reviews, and quality projects 
•    Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes. 
•    Improves health care professional relations through direct communication, knowledge of appropriate evidence-based clinical information, and the fostering of positive collegial relationships.
•    Addresses customer service issues with mentoring and support from leadership staff.
•    Investigates and responds to client and/or regulatory questions to assist in resolving issues or clarifying questions with mentoring and support from leadership staff. 
•    Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both timely turn-around of coverage reviews and quality outcomes based on those review decisions.
•    Provides clinical insight and management support to other functional areas and matrix partners as needed or directed.Company Medicare
•    Directs and implements medical policy and ensures the quality of medical care provided to customers/members for single-market health plans
•    Responsible for chairing appropriate health services committees and providing leadership for pharmacy and health services utilization management projects for single-market health plans Minimum Requirements

•    Current unrestricted medical license in a US state or territory
•    Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty 
•    Exhibits ethical and professional behavior.
•    Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency
•    Computer Competency Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs are used extensively and competency in all must be possessed or rapidly acquired.  

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